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    (Please Fill With Big Letter Only) : Application Form

    Uploaded by

    Enrique Ventolero
    This document is an application form for employment. It requests personal information such as name, date of birth, contact details, nationality, marital status, bank details, documentation like passport and license numbers, sea service history for the last 3 years, medical information, and a signature releasing the information for recruitment purposes. Fields are provided to describe height, weight, clothing size, shoe size, eye color, and hair color. Space is given to list references and reasons for applying to the particular employer.

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    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd

    (Please Fill With Big Letter Only) : Application Form

    Uploaded by

    Enrique Ventolero
    28 views2 pages
    This document is an application form for employment. It requests personal information such as name, date of birth, contact details, nationality, marital status, bank details, documentation like passport and license numbers, sea service history for the last 3 years, medical information, and a signature releasing the information for recruitment purposes. Fields are provided to describe height, weight, clothing size, shoe size, eye color, and hair color. Space is given to list references and reasons for applying to the particular employer.

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    This document is an application form for employment. It requests personal information such as name, date of birth, contact details, nationality, marital status, bank details, documentation like passport and license numbers, sea service history for the last 3 years, medical information, and a signature releasing the information for recruitment purposes. Fields are provided to describe height, weight, clothing size, shoe size, eye color, and hair color. Space is given to list references and reasons for applying to the particular employer.

    Copyright:

    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd
    Download as pdf or txt
    28 views2 pages

    (Please Fill With Big Letter Only) : Application Form

    Uploaded by

    Enrique Ventolero
    This document is an application form for employment. It requests personal information such as name, date of birth, contact details, nationality, marital status, bank details, documentation like passport and license numbers, sea service history for the last 3 years, medical information, and a signature releasing the information for recruitment purposes. Fields are provided to describe height, weight, clothing size, shoe size, eye color, and hair color. Space is given to list references and reasons for applying to the particular employer.

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    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd
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    PHOTO

    SIZE:
    APPLICATION FORM 4,5x3,5
    (Please fill with big letter only)

    PERSONAL DATA
    POSITION APPLY READINESS TO START

    NAME SURNAME

    DATE OF BIRTH PLACE OF BIRTH

    HOME ADDRESS POST CODE, CITY

    NATIONALITY E-MAIL

    TELEPHONE MOBILE/FAX
    NUMBER OF SUPPORTED
    MATRIMONIAL STATUS CHILDREN UNDER AGE OF 18
    NEXT OF KIN
    NAME & ADDRESS
    NEXT OF KIN
    RELATIONSHIP
    TELEPHONE/MOBILE
    ADDRESS OF BANK,
    NAME OF BANK POST CODE, CITY
    ACCOUNT NO
    SWIFT
    EURO
    OWNER OF THE HOME ADDRESS OF
    BANK ACCOUNT THE OWNER

    DOCUMENTATION
    NUMBER ISSUED PLACE VALID
    PASSPORT

    SEAMAN’S BOOK

    TYPE OF LICENSE

    NO OF LICENSE:

    STCW-95 COURSES NUMBER ISSUED VALID


    GMDSS

    BASIC SAFETY TRAINING IN PERSONAL SAFETY & RESPONSIBILITY

    BASIC SAFETY TRAINING IN PERSONAL SURVIVAL TECHNIQUES (ITR)

    CERTIFICATE OF PROFICIENCY IN SURVIVAL CRAFT & RESCUE BOATS

    TRAINING IN FIRST/ ADVANCED FIRE FIGHTING*

    TRAINING IN MEDICAL CARE/ FIRST AID/ELEMENTARY FIRST AID *

    HEALTH CERTIFICATE
    ENDORSEMENTS (if any)

    ST. VINCENT & THE GRENADINES, MALTA OR SLOVAK

    HEIGHT: WEIHGT: COLOR OF SIZE OF M L SIZE OF COLOR OF


    CM KG EYES CLOTHES* XL XXL SHOES HAIR

    *Właściwe zakreślić
    REFERENCES:
    NAME OF AGENCY ADRESS/TELEPHONE
    SEA SERVICE: Please list sea service for minimum the last 3 (three) years (as given at the Seamen’s Book)

    DECK TYPE OF PERIOD OF SERVICE


    CREW VESSEL(TUG,
    LIST GT CONTAINER, etc) PHONE NO TO FROM TO
    NAME OF THE CREWING
    ENGINEERS TYPE OF FLAG SHIPPING COMPANY THE CREWING
    LP. NAME OF VESSEL AGENCY POSITION
    LIST POWER ENGINE (MAK, AGENCY
    year month day year month day
    (KW) DEUTZ, MAN,
    etc)
    1

    10

    Please write here in a few words reason of applying for a job in JAN STĘPNIEWSKI I SKA, please inform about the reason of changing the
    employee and/or give additional information, which may be important or should be known by our Crewing Agency:

    Ja niżej podpisany oświadczam, że zamieszczone w niniejszym formularzu dane są prawdziwe i wyrażam zgodę na ich przetwarzanie i przekazywanie ich
    za granicę dla potrzeb niezbędnych do realizacji procesu rekrutacji (zgodnie z ustawą z dnia 29.08.1997 o ochronie danych osobowych, Dz. U. Nr 133 poz.
    883)

    Miejscowość/Place: Dnia/Date: Imię i nazwisko/Name: Podpis/ Signature

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